CMV 血清阳性的异基因造血干细胞移植患者 COVID-19 患者的转归改善和死亡率升高：来自欧洲血液和骨髓移植学会登记处传染病工作组的研究。

Improved outcomes over time and higher mortality in CMV seropositive allogeneic stem cell transplantation patients with COVID-19; An infectious disease working party study from the European Society for Blood and Marrow Transplantation registry.

机构信息

Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital Huddinge, Stockholm, Sweden.

Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.

出版信息

Front Immunol. 2023 Mar 7;14:1125824. doi: 10.3389/fimmu.2023.1125824. eCollection 2023.

INTRODUCTION

COVID-19 has been associated with high morbidity and mortality in allogeneic hematopoietic stem cell transplant (allo-HCT) recipients.

METHODS

This study reports on 986 patients reported to the EBMT registry during the first 29 months of the pandemic.

RESULTS

The median age was 50.3 years (min - max; 1.0 - 80.7). The median time from most recent HCT to diagnosis of COVID-19 was 20 months (min - max; 0.0 - 383.9). The median time was 19.3 (0.0 - 287.6) months during 2020, 21.2 (0.1 - 324.5) months during 2021, and 19.7 (0.1 - 383.9) months during 2022 (p = NS). 145/986 (14.7%) patients died; 124 (12.6%) due to COVID-19 and 21 of other causes. Only 2/204 (1%) fully vaccinated patients died from COVID-19. There was a successive improvement in overall survival over time. In multivariate analysis, increasing age (p<.0001), worse performance status (p<.0001), contracting COVID-19 within the first 30 days (p<.0001) or 30 - 100 days after HCT (p=.003), ongoing immunosuppression (p=.004), pre-existing lung disease (p=.003), and recipient CMV seropositivity (p=.004) had negative impact on overall survival while patients contracting COVID-19 in 2020 (p<.0001) or 2021 (p=.027) had worse overall survival than patients with COVID-19 diagnosed in 2022.

DISCUSSION

Although the outcome of COVID-19 has improved, patients having risk factors were still at risk for severe COVID-19 including death.

介绍

COVID-19 在异基因造血干细胞移植（allo-HCT）受者中与高发病率和死亡率相关。

方法

本研究报告了在大流行的前 29 个月内向 EBMT 登记处报告的 986 名患者。

结果

中位年龄为 50.3 岁（最小-最大；1.0-80.7）。从最近一次 HCT 到 COVID-19 诊断的中位时间为 20 个月（最小-最大；0.0-383.9）。2020 年中位时间为 19.3（0.0-287.6）个月，2021 年为 21.2（0.1-324.5）个月，2022 年为 19.7（0.1-383.9）个月（p=NS）。986 例患者中有 145 例（14.7%）死亡；124 例（12.6%）死于 COVID-19，21 例死于其他原因。仅 2/204（1%）完全接种疫苗的患者死于 COVID-19。随着时间的推移，总生存率呈连续改善。多变量分析显示，年龄增加（p<.0001）、表现状态恶化（p<.0001）、HCT 后 30 天内（p<.0001）或 30-100 天内（p=.003）感染 COVID-19、持续免疫抑制（p=.004）、预先存在的肺部疾病（p=.003）和受体 CMV 血清阳性（p=.004）对总生存率有负面影响，而 2020 年（p<.0001）或 2021 年（p=.027）感染 COVID-19的患者总生存率差于 2022 年诊断为 COVID-19的患者。